Wiki E & M question

[dpumford]

I have a couple of questions

When the doctor does the PFSH and marks a comprhensive exam(99223), does all three PFSH have to be noted? He has "Not Significant", Under Family medical history.

Under the Physical Exam: If the doctore has noted under Genital/Rectal: Examination deferred to the primary physician..can you count this as a Organs System.? We are doing 1995 guidelines..

I have be told yes & no so I am hoping someone can asssit me in finding the true answer..I am in Mich so WPS is are Medicare contractor.

I have one more Am I correct when saying that if a pt is seen as an out-pt hospital
(99220) and is schedule for a CABG in one week. This would still fall under High Decision Making because the patient is having a elective major surgery... even thought he went home after the evaluation~

Thanks!

 

[jdibble]

When the doctor does the PFSH and marks a comprhensive exam(99223), does all three PFSH have to be noted? He has "Not Significant", Under Family medical history.

For a 99223 you must have all three PFSH documented. Highmark is our Medicare carrier and they do allow the statement of non-contributory for the Family history only. So, I would check with WPS to see if they accept this statement - if they do, I would think this would be acceptable. If not, then no you do not have a complete PFSH.

Under the Physical Exam: If the doctore has noted under Genital/Rectal: Examination deferred to the primary physician..can you count this as a Organs System.? We are doing 1995 guidelines

No - the doctor has to phsycially perform the exam of that system for it to count. He cannot take credit for the work of another physician.

I have one more Am I correct when saying that if a pt is seen as an out-pt hospital
(99220) and is schedule for a CABG in one week. This would still fall under High Decision Making because the patient is having a elective major surgery... even thought he went home after the evaluation~

Code 99220 is an Observation code. Was the patient placed in Observation and who placed him there? If the admitting doctor is stating that the patient is just scheduled for the procedure, I would't think he can claim that to go towards his documentation for high risk. Usually the specialist is the one making that decision - unless he is the admitting doctor he would be doing either a consult (non-medicare) or using the outpatient office codes and he would claim the High Risk from deciding to perform the CABG. However, a patient who is in Observation for cardiac may qualify for High Risk decision making based on other factors, so the CABG surgery may not be the only criteria needed to meet the higher level.

Hope this helps.

Thanks,